Permit p CITY OF TIGARD PLUMBING PERMIT
IIII e . COMMUNITY DEVELOPMENT Permit#: PLM2015-00116
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/15/2015
Parcel: 2S110BC12400
Jurisdiction: TIGARD
Site address: 14773 SW 122ND PL
Project: Troy Park,Lot 10 Subdivision: TROY PARK Lot: 10
Project Description: Backflow preventer for irrigation.
Contractor: TRADEMARK LANDSCAPES INC Owner: TIMBERLAND HOMES, INC.
PO BOX 2410 12670 SW 68TH AVE#300
OREGON CITY, OR 97006 TIGARD,OR 97223
PHONE: 503-631-3893 PHONE: 503-620-8860
FAX: 503-631-4737
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/15/2015 $31.27
Specifics: 1 12%State Surcharge- 04/15/2015 $8.70
Plumbing
Type of Use: SF 41 ea Minimum Fee Adjustment- 04/15/2015 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: SIP ,. ,
"`" - /
-4111 .,ice..
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application r�
Site Utilities - ,,v‘Nt1) FOR Ohf l(F: I tiI1 O.NLl
City of Tigard ► 1 Received ,J
De eiv : ,®1 Permit No.: I I. • -/.I,
111111
■ 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review
• Phone: 503.71.8.2439 Fax: 503.598.1960 215 other Permit No.:
15 Date/By: /rlsrPp(y-(Jo i
l.1 c; D Inspection Line: 503.639.4175 p,P R Date Ready/By: h,ris ® Sec Page 2 for
Internet: www.tigard-or.gov i c I i NAL Notified/Method: 1 Supplemental Information
TYPE'OF WO' 'i �1 4 . . FEE* SC14ED1ILE
■ New construction ❑,Epj,1 3 1 For special information use checklist
lJi� Description i Qty. [ Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
11-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Firs;sprinkler( sq.ft.) _ Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I t.�'�'7 3 `}W 2 h-;),, Catch basin or area drain 18.76 -
CitylState/Zip: fl �� 4` -1-72.2'4 Drywell,leach line,or trench drain 18.76
I n Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name:-� f L b,tt.{- t 0 Manufactured home utilities 50.03
Cross street/directions to job site: y.Cr w i,v t. Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: --'�Y, 6,04_ j Lot no.: t Fixture or item: _
Tax map/parcel no.: `' Backflow preventer 1 31.27 1�(. L�j
DESCRIPTION OF WORK Backwater valve 12.51
( Clothes washer 25.02
1 Ui�u, }''-' a.4j (l 1 Dishwasher 25.02
I ��,/L"tJ Drinking fountain 25.02
Ejectors/sump 25.02
9t PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: ,nti,1k4'4,4444.614 Jim, .
Floor drain/floor sink/hub 25.02
Address: 1 Z i'7 G S U✓U S'1-k ea. ,(Li:C., 36
�1 t Garbage disposal 25.02
City/State/ZIP: �) L 1-7 Z Hose bib 25.02
Phone:(5 i',._,),) (p 2...6- (,,;V Fax:(5)C1') c -ri C 5 } Ice maker 12.51
V. APPLICANT, ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:�iti tit.(.'�a } r 1;,(', , Medical gas(value:$ ) Page 2
ttr l�
Contact name: i --� Primer 12.51
L �` I t((k Roof drain(commercial) 12.51
Address: 1 2_,f i-'� t ,S Div biol., -�S�k��Ci D Sink/basin/lavatory 25.02
City/State/ZIP: l .0' L.t )-)t_, G ,:3 Solar units(potable water) 62.54
Tub/shower/shower pan 12.51
Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
• Water piping/DWV 56.29
Other: 25.02
Subtotal -3),) 7
Fax:(3,0 3) 6 11_.y-7 2 Minimum permit fee: $72.50 21.572
J J Plan review (25%of permit fee)
Plumbing Lic.no.:
State surcharge(12%of permit fee) 8- 70
Authorized signature: `._./i ,i , L._,i TOTAL PERMIT FEE g/
(� ,j j Y /if J , This permit application expires if a permit is not obtained within 180 days
Print name: /,l�L,L.jjt i Date:
after it has been accepted as complete.
"Fee methodology set by Tn.-County Building Industry Service Board.
I:\Building\I'ermits\PLMU-PermitApp.doc IP/01N9 440.4616T(10/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14773 SW 122ND PL, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
FAIL
PLM2015-00116
George Heimos
1. Back flow device requires a minimum 12” clear space below device to ground with
box. 603.3.3
2. Recall when completed
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14773 SW 122ND PL, TIGARD, OR, 97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00116
George Heimos
1" Febco model 850, serial number HD77236
Violation Summary:
Inspector Contractor